The board game Kaledo was proven to be effective in improving nutrition knowledge and in modifying dietary behavior in students attending middle and high school. The present pilot study aims to reproduce these results in younger students (7–11 years old) attending primary school. A total of 1313 children from ten schools were recruited to participate in the present study. Participants were randomized into two groups: (1) the treatment group which consisted of playing Kaledo over 20 sessions and (2) the no intervention group. Anthropometric measures were carried out for both groups at baseline (prior to any treatment) and at two follow-up post-assessments (8 and 18 months). All the participants completed a questionnaire concerning physical activity and a 1-week food diary at each assessment. The primary outcomes were (i) BMI z-score, (ii) scores on physical activity, and (iii) scores on a dietary questionnaire. BMI z-score was significantly lower in the treated group compared to the control group at 8 months. Frequency and duration of self-reported physical activity were also significantly augmented in the treated group compared to the control group at both post-assessments. Moreover, a significant increase in the consumption of healthy food and a significant decrease in junk food intake were observed in the treated group.
Conclusion: The present results confirm the efficacy of Kaledo in younger students in primary schools, and it can be used as a useful nutritional tool for obesity prevention programs in children.
What is Known:
• Kaledo is a new educational board game to improve nutrition knowledge and to promote a healthy lifestyle.
• In two cluster randomized trials conducted in Campania region (Italy), we showed that Kaledo could improve nutrition knowledge and dietary behavior and have a positive effect on the BMI z-score in children with age ranging from 9 to 14 years old attending school.
• Kaledo may be used as an effective tool for obesity prevention programs in middle and high school students.
What is New:
• Investigating the effects of Kaledo on younger primary school children (7–11 year olds), Kaledo could be an effective tool in obesity prevention programs for children as young as 7 years old.
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Lombardo FL, Spinelli A, Lazzeri G, Lamberti A, Mazzarella G, Nardone P, Pilato V, Buoncristiano M, Caroli M, OKkio alla SALUTE Group 2010 (2015) Severe obesity prevalence in 8- to 9-year-old Italian children: a large population-based study. Eur J Clin Nutr 69:603–608
Cacciari E, Milani S, Balsamo A, Spada E, Bona G, Cavallo L, Cerutti F, Gargantini L, Greggio N, Tonini G, Cicognani A (2006) Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Investig 29(7):581–593. https://doi.org/10.1007/BF03344156
Barlow SE, Trowbridge FL, Klish WJ, Dietz WH (2002) Treatment of child and adolescent obesity: reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics 110(1 Pt 2):229–235
Bartfay WJ, Bartfay E (1994) Promoting health in schools through a board game. West J Nurs Res 16(4):438–446. https://doi.org/10.1177/019394599401600408
Brown SJ, Lieberman DA, Germeny BA, Fan YC, Wilson DM, Pasta DJ (1997) Educational video game for juvenile diabetes: results of a controlled trial. Med Inform (London) 22(1):77–89. https://doi.org/10.3109/14639239709089835
Baranowski T, Baranowski J, Cullen KW, Marsh T, Islam N, Zakeri I, Honess-Morreale L, deMoor C (2003) Squire’s Quest! Dietary outcome evaluation of a multimedia game. Am J Prev Med 24(1):52–61
Viggiano A, Viggiano E, Di Costanzo A, Viggiano A, Andreozzi E, Romano V, Rianna I, Vicidomini C, Gargano G, Incarnato L, Fevola C, Volta P, Tolomeo C, Scianni G, Santangelo C, Battista R, Monda M, Viggiano A, De Luca B, Amaro S (2015) Kaledo, a board game for nutrition education of children and adolescents at school: cluster randomized controlled trial of healthy lifestyle promotion. Eur J Pediatr 174(2):217–228. https://doi.org/10.1007/s00431-014-2381-8
Amaro S, Viggiano A, Di Costanzo A, Madeo I, Viggiano A, Baccari ME, Marchitelli E, Raia M, Viggiano E, Deepak S, Monda M, De Luca B (2006) Kalèdo, a new educational board-game, gives nutritional rudiments and encourages healthy eating in children: a pilot cluster randomized trial. Eur J Pediatr 165(9):630–635. https://doi.org/10.1007/s00431-006-0153-9
Booth M, Okely A, Chey T, Bauman A (2001) The reliability and validity of the physical activity questions in the WHO health behaviour in schoolchildren (HBSC) survey: a population study. Br J Sports Med 35(4):263–267. https://doi.org/10.1136/bjsm.35.4.263
Lakshman RR, Sharp SJ, Ong KK, Forouhi NG (2010) A novel school-based intervention to improve nutrition knowledge in children: cluster randomised controlled trial. BMC Public Health 10(1):123. https://doi.org/10.1186/1471-2458-10-123
Charlier N, De Fraine B (2013) Game-based learning as a vehicle to teach first aid content: a randomized experiment. J Sch Health 83(7):493–499. https://doi.org/10.1111/josh.12057
Kaledo was patented by Bruno De Luca and Salvatore Amaro as members of the non-profit organization Associazione Culturale Kaledo. At present, this national patent has expired.
This research was funded by the Second University of Naples, Associazione Culturale Kaledo, Regione Campania, Provincia di Napoli, and Provincia di Salerno. The authors would like to thank the principals and teachers of the primary schools for their collaboration and free participation in the research.
This study was funded by the Second University of Naples, Associazione Culturale Kaledo, Regione Campania, Provincia di Napoli, and Provincia di Salerno.
Conflict of interest
The authors declare that they have no conflict of interest
All procedures performed in this study were in accordance with the ethical standards of the Second University of Naples and in accordance with the current international guidelines, the standards on human experimentation of the Ethics Committee of the Second University of Naples, Italy, and with the Helsinki Declaration of 1975, revised in 1983.
Informed consent was obtained from the parents of the children who participated in the study.
Communicated by Mario Bianchetti
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Viggiano, E., Viggiano, A., Di Costanzo, A. et al. Healthy lifestyle promotion in primary schools through the board game Kaledo: a pilot cluster randomized trial. Eur J Pediatr 177, 1371–1375 (2018). https://doi.org/10.1007/s00431-018-3091-4
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